BackgroundSubjective cognitive complaints are common in older populations and may signpost incident Alzheimer's disease and related dementias.ObjectiveTo determine the frequency and predictors of cognitive impairment and dementia among Yoruba-speaking community dwelling older persons (65 years and above) from 2 communities in Oyo State, Southwest Nigeria who have Subjective cognitive complaints.MethodsThis was a cross-sectional, observational study conducted within two urban communities in Oyo State, South West Nigeria and involving 150 consenting and voluntarily participating elderly participants aged 65 years and above who had subjective cognitive complaints. Demographic and clinical data were obtained using a pro forma. Participants also had cognitive screening and a focused clinical examination by a physician. Categorization following consensus diagnosis was according to International Classification of Diseases version 11 (ICD-11) namely dementia, mild cognitive impairment and no cognitive impairment.ResultsThere were no statistically significant differences in the socio-demographic and cognitive performance scores on neuropsychological testing across sites. At final diagnosis, 4 participants had dementia (2.7%) while 15 participants (10%) had mild cognitive impairment. On logistic regression, only moderate-severe decline on the Clinical Dementia Rating Scale was significantly associated with higher odds of cognitive decline in this sample.ConclusionsAbout 1 in 7 older persons in this study already had objective cognitive decline. Subjective cognitive complaints in older Yoruba Africans should prompt early screening. Prospective studies to identify the consistent predictors of cognitive decline in this population are needed.

Objectives: The objective of the study is to systematically characterise the types and patterns of cutaneous manifestations observed in patients with various endocrine disorders and to differentiate and document the specific and non-specific dermatological changes linked to endocrine abnormalities. Materials and Methods: After obtaining ethics committee clearance and written informed consent from individual study participants, patients who attended the dermatology outpatient department of our tertiary care hospital with endocrine diseases from January 2021 to December 2022 were included. A pre-set pro forma was used to collect data on demography and clinical findings including dermatological manifestations and laboratory parameters. We noted the different endocrinal diseases along with the mucocutaneous findings in the study participants. We classified the mucocutaneous manifestations associated with endocrinal diseases into specific and non-specific. Results: Over a 2-year observational period, 150 patients diagnosed with endocrinal disorders who attended the outpatient department were included in the study. The distribution of these endocrinal conditions was as follows: Diabetes mellitus in 88 patients (58.66%), hypothyroidism in 39 patients (26%), hyperthyroidism in 12 patients (8%) and Cushing’s syndrome in six patients (4%). Most common mucocutaneous manifestations noted amongst the study cohort were generalised pruritus, dry coarse skin and diffuse hair fall. Amongst individuals diagnosed with diabetes mellitus, the predominant cutaneous findings were generalised pruritus (25 patients, 28.41%) and dermatophytoses, specifically tinea cruris and tinea corporis (10 patients, 11.36%). In those with hypothyroidism, the most common issues were generalised pruritus (15 cases, 38.46%) and dry, coarse skin (13 cases, 33.33%). The most common manifestations reported in patients with hyperthyroidism were generalised pruritus (4 cases, 33.33%) followed by warm moist skin (3 cases, 25%). Conclusion: All 150 patients who attended the dermatology OPD with endocrinal disorders along with any mucocutaneous findings, points to the importance of detailed dermatological evaluation in patients with endocrinal diseases to offer comprehensive care, which points to the importance of detailed dermatological evaluation in patients with the former to offer comprehensive care to the affected. Awareness of specific mucocutaneous features of endocrinal diseases may help the dermatologist to offer proper evaluation and early diagnosis of endocrinal diseases.

BackgroundSARS-CoV-2, a novel coronavirus, initially appeared in Wuhan, China, at the end of 2019 and has infected more than 31 million people worldwide. Infection can range from asymptomatic to multiorgan failure requiring prompt treatment. Overall, 80% of patients with SARS-CoV-2 experienced mild to moderate illness, while 5% developed serious illness. Physicians can evaluate a patient’s digestive system (Koshtha), digestive capacity (Agni), strength (Bala), and longevity (Ayu) using the body constitution (Deha Prakriti). It also helps doctors estimate a patient’s illness risk, severity, disease activity scores, and hematological, pathological, and biochemical changes. The study investigated the association between body composition (Deha Prakriti) and severity, as shown by structural lung abnormalities in patients with SARS-CoV-2.ObjectiveThis study aims to study the correlation between the severity of Prakriti and structural alterations in the lungs of patients with SARS-CoV-2.MethodsThis is a retrospective cross-sectional study of patients with SARS-CoV-2. The research data will be retrospectively collected from hospital records between September 1, 2020, and May 11, 2021, a period during which India experienced the second wave of the pandemic. The data will come from the Acharya Vinoba Bhave Rural Hospital in Sawangi (Meghe), Wardha, Maharashtra, India. Patients will be contacted via telephone and encouraged to visit the outpatient department and inpatient department at these institutions or in rural and urban areas of Wardha city. A structured case pro forma and a Prakriti assessment questionnaire will be used to evaluate lung structural changes during the COVID-19–positive period.ResultsThe study is not funded by any organization. The study was initiated on March 4, 2023, and as of July 1, 2024, a total of 265 patients have been recruited. Results will be recorded from the observations of subjective and objective parameters. The study’s primary outcome is to establish a relationship between abnormalities in the structure of the lungs in patients with COVID-19 and body constitution (Prakriti). The study’s secondary outcome will help identify which body constitution is most susceptible to structural changes and disease severity in patients with COVID-19 and will also offer insights into preventive medicine.ConclusionsStatistical investigation will lead to the conclusion that there is a specific association between structural abnormalities in the lungs of patients with COVID-19 and their body constitution. We hypothesize that Prakriti will be identified as being more prone to structural changes and severity in patients with COVID-19, offering insights into preventive therapy.

Hypertension is a major non-communicable disease of public health concern. In Nigeria, the rate is between 28% and 42.2%. Hypertension or the prolonged use of some antihypertensive drugs has been associated with hearing loss in studies. There is a paucity of studies on this in our environment. Therefore, this study aims to evaluate the relationship between hearing thresholds and hypertension. This was a hospital-based cross-sectional comparative study of hypertensive and non-hypertensive patients. Ethical approval for the study was obtained. Informed consent was obtained from the participants. A researcher-administered structured pro forma was utilised to obtain demographic and medical history data. Blood pressure measurement and pure-tone audiometry were performed on all the participants. Data were analysed using SPSS version 25. One hundred and twenty-eight participants each were recruited from the hypertensive and control groups for the study. The age range of the hypertension group was 27-60 years. The frequency of hearing loss amongst the hypertension and control groups was 47.7% and 15.6%, respectively (P < 0.001). The mean pure-tone average for the hypertension group was 29.2 dB ± 18.5/28.3 dB ± 20.5 and 21.6 dB ± 8.7/20.6 dB ± 8 in the right and left ears of the hypertensive and control groups, respectively. The frequency of hearing loss in the controlled and uncontrolled hypertensive subjects was 44.7% and 52%, respectively (P = 0.424). Hearing loss frequency was 50% in hypertensive subjects on diuretic and/or beta-blockers and 46% in those on other antihypertensive drugs (P = 0.650). The frequency of hearing loss in the hypertension group was significantly higher than in the control group.

Background: Coronary artery disease (CAD) remains a leading cause of morbidity and mortality worldwide, with a rising burden in low-resource regions, such as Bundelkhand. Acute coronary syndrome (ACS), a common presentation of CAD, often manifests with varied demographic and angiographic profiles influenced by regional risk factor patterns. Aims and Objectives: To assess the demographic characteristics, cardiovascular risk factors, and angiographic patterns of CAD in patients presenting with ACS in the Bundelkhand region. Materials and Methods: This cross-sectional observational study included 150 consecutive ACS patients (ST-Elevation Myocardial Infarction [STEMI], Non-STEMI, or unstable angina) admitted to Maharani Laxmi Bai Medical College, Jhansi, from April 2024 to March 2025. Data on demographics, risk factors, and clinical presentation were collected using a structured pro forma. All patients underwent electrocardiogram, cardiac biomarkers, echocardiography, and coronary angiography. Statistical analysis was performed using SPSS v21, with P&lt;0.05 considered significant. Results: Males predominated (80.67%), especially in the 30–50 years group (P=0.04). STEMI was the most common presentation (68.67%), with anterior wall myocardial infarction leading (44.67%). Hypertension (44%), dyslipidemia (41.33%), and diabetes mellitus (30%) were the most frequent risk factors. Angiography revealed single vessel disease (SVD) in 56%, double vessel disease (30%), and triple vessel disease (14%). The left anterior descending (LAD) artery was most involved (28% in SVD). Diabetes and hypertension showed a significant association with multivessel disease (P=0.003 each). Conclusions: ACS in Bundelkhand predominantly affects middle-aged males, with LAD-predominant SVD as the commonest angiographic finding. Diabetes and hypertension significantly influence disease severity, underscoring the need for early detection and aggressive risk factor control.

Abstract Aim To evaluate compliance with established referral standards for the Surgical Acute Ambulatory Care Unit (AACU) and assess the appropriateness and outcomes of referrals received over a defined period. Method A prospective audit was conducted between April 14th and May 9th, 2025, involving 151 patients referred to the Surgical AACU. Data were collected using a structured pro forma capturing referral source, presenting complaint, NEWS at referral, diagnosis, and clinical outcome. Compliance was assessed against NHS Improvement and Ambulatory Emergency Care Network (2018) guidelines for same-day emergency care. Results Only 62% of referrals met AACU selection criteria. Of the 38% deemed inappropriate, 31 cases could have been managed in GP or outpatient settings, and 23 required full admission. Most referrals originated from the Emergency Department (57), followed by ACU review (32), ward review (24), GPs (19), and surgical team (15). Blood tests were the most common intervention (105), followed by clinical assessment (73) and imaging (55). small amount of referrals were made for pre-operative checks, and a small number were for inappropriate purposes such as breaking bad news. Biliary colic (35) and post-op wound issues (24) were the most common presentations. Overall, 75% of patients were appropriately managed and discharged on the same day, with a 15% admission rate falling within acceptable NHS thresholds. Conclusions The audit highlights the effectiveness of the AACU when used appropriately but reveals a significant proportion of inappropriate referrals. Improved gatekeeping, clearer referral pathways, and targeted education are recommended to enhance efficiency and ensure guideline-based use.

Facial dermatoses constitute a diverse group of skin conditions that can significantly impact patients' quality of life due to the cosmetic and psychological implications. Understanding the clinico-epidemiological patterns of these conditions aids in timely diagnosis and effective management. This study aims to determine the clinical and epidemiological profile of patients presenting with facial dermatoses in a tertiary care dermatology outpatient setting. A descriptive cross-sectional study was conducted in the Department of Dermatology, Venereology, and Leprology of a tertiary care hospital over 18 months (April 2023 to September 2024). Four hundred patients (n=400) of all ages and both sexes presenting with facial dermatoses were enrolled consecutively. A structured pro forma was used to collect demographic and clinical data. Relevant investigations, such as potassium hydroxide mount, Wood's lamp examination, and skin biopsy, were performed as indicated. Data were analyzed using Epi Info v3.4.5 and 7.1.5 (U.S. Centers for Disease Control and Prevention, Atlanta, GA, USA). Out of 400 patients, 242 (60.5%) were females and 158 (39.5%) were males. The most affected age group was 21-30 years, comprising 114 (28.5%) patients. Pigmentary disorders were the most common category, observed in 123 (30.8%) patients, with melasma being the leading condition, affecting 82 (20.5%) patients. Infectious dermatoses were seen in 95 (23.8%) cases, with tinea faciei being the most frequent, affecting 42 (10.5%) patients. Acne vulgaris was present in 65 (16.3%) patients, and eczema in 48 (12%) patients. A significant association was found between pigmentary dermatoses and female gender (p<0.05). Seasonal variation and history of prior treatment were noted in a considerable number of patients, accounting for 176 (44%) and 139 (34.8%) cases, respectively. Facial dermatoses are more prevalent in young adults and females, with pigmentary disorders, infections, and acne being the most frequent presentations. The findings underscore the importance of public awareness, early intervention, and further research to investigate risk factors and develop effective preventive strategies.

This research aimed to explore the link between diabetic nephropathy and diastolic dysfunction in individuals with type 2 diabetes mellitus (T2DM), as the precise impact of diabetes on left ventricle diastolic function in patients with chronic renal failure is limited. This cross-sectional study was conducted in the department of general medicine at tertiary care center, over 18 months. This study includes both men and women aged more than 35 years (>35-<70 years) with known or newly diagnosed diabetes mellitus. Involved participants with diabetes mellitus diagnosed using the American Diabetes Association criteria. Diabetic nephropathy was assessed using urine albumin and serum creatinine levels. Patients underwent a two-dimensional-directed M-mode transthoracic echocardiogram and mitral valve inflow assessment. Diastolic dysfunction was classified into three grades, and tissue Doppler imaging was used to measure the E/E' ratio. Data were collected using a predesigned pro forma and entered into an Excel spreadsheet. The study aimed to understand the relationship between diabetes and kidney function. The study involved 101 patients with T2DM, with a mean age of 53.46 ± 9.96 years. Diastolic dysfunction was observed in 57.4% of the population, with 34.7% having Grade I dysfunction, 18.8% having Grade II dysfunction, and 4.0% having Grade III dysfunction. The prevalence of diastolic dysfunction was higher among males (64.3%) compared to females (48.9%). Age-wise distribution showed 66.7% of patients with diastolic dysfunction, while no significant association was found between diabetes duration and diastolic dysfunction. Lipid profile analysis revealed significantly higher low-density lipoprotein levels in patients with diastolic dysfunction compared to those without. A direct relationship between worsening diabetic nephropathy and diastolic dysfunction was found. A significant correlation was found between declining estimated glomerular filtration rate and worsening diastolic dysfunction. The study reveals a high prevalence of left ventricular diastolic dysfunction (LVDD) in type 2 diabetes, linked to age, diabetes duration, poor glycemic control, and diabetic nephropathy. The study suggests that glycemic control and diabetes duration may be more dominant determinants of LVDD. Early detection and aggressive management are crucial to mitigate the risk.

Context:Restorative dentistry plays a critical role in maintaining oral health, function, and esthetics by repairing damaged or decayed teeth. Restoration failures can arise from several factors, such as material degradation, improper technique, patient-specific oral conditions.Aim:The present study aimed to evaluate the incidence of restoration failure among different permanent restorative materials and to analyze the causes of restoration failure.Materials and Methods:Four-hundred patients were examined for restoration failure over a time period of 19 months, reported at the outpatient section of the department of conservative dentistry and endodontics. A self-structured pro forma was designed, and each patient was given a code number. The details about the patient and causes of failure of permanent restorations were obtained by using a questionnaire which included information on patient’s oral hygiene habits and history of restoration placement.Statistical Analysis:Data obtained were statistically analyzed by the Chi-square test.Result and Conclusion:Statistically significant differences (P < 0.0001) were found in the case of age groups, reason of replacement, and the class of restoration. The main cause of the failure was secondary caries, followed by microleakage and bond failure. Composite was the most commonly replaced restorative material, and mandibular molar teeth showed maximum failures. It also indicated that replacements were more prevalent in males.

Clinical Evaluation of a Novel Deintensified Surveillance Protocol for Low-risk Non-muscle-invasive Bladder Cancer: A Prospective Study in 250 Patients.

Abstract Background: Depression is a serious mental health condition, among which major depressive disorder (MDD) is the most common. The prevalence of depression reported in general Indian studies of medical outpatients is estimated to range from 4.3% to 39.3%. Nutool (dripping of fluid) is a popular Unani treatment for mental and psychological disorders ( Amrāḍ-i-Nafsāniyya ). Nutool induces a peaceful state of awareness that results in a dynamic psycho-somatic balance. Aims and Objectives: The present clinical trial was conducted to evaluate the antidepressant effect and safety of Nutool therapy in the management of depression. Methodology: A randomized clinical trial was conducted at the Department of Ilaj-bit-tadbeer, AKTC Hospital, Aligarh Muslim University, Aligarh. A total of 60 patients with depression were enrolled for the study from the Psychiatry outpatient department (OPD) of JNMCH and the IBT OPD of AKTCH, Aligarh, based on DSM-5 diagnostic criteria. Severity was assessed using the Hamilton Depression Rating Scale (HDRS-17) on the visiting day. Patients with HDRS-17 scores &gt;7 were included in the study after selection based on a semi-structured performa. Participants aged 18–60 years, of either sex, were included as per protocol. The participants were divided into two groups: Group A consisted of 30 patients who received medicated water Nutool therapy with a decoction of gul-i-banafsha (Viola odorata) and gul-i-nilofer (Nympha alba), while Group B included 30 patients who received plain water Nutool therapy at the same temperature. Nutool therapy was administered thrice in the 1 st week and twice in the next 2 weeks, with a total study period of 21 days. Results and Observations: Improvements or deteriorations in disease conditions were documented in the pro forma, and the results were analyzed statistically. At the end of treatment, significant improvement ( P &lt; 0.001) was observed in clinical symptoms. Subjective parameters, such as sleep and appetite, showed marked improvement. Objective parameters, including HDRS-17 scores, demonstrated statistically significant reductions in both groups. Discussion and Conclusion: Nutool therapy yielded positive results in both groups, indicating a biophysical therapeutic effect rather than relying solely on the pharmacological action of the liquid used. This study concludes that the selected herbal preparation and Nutool therapy are both effective and safe for managing MDD. The findings highlight the potential for integrating Nutool therapy into broader treatment protocols for depression. Further research with larger sample sizes and extended follow-up periods is recommended to substantiate these findings.

Background: Iatrogenic urogenital fistula is a serious and preventable complication of gynecological and obstetric procedures, leading to significant physical, psychological, and social consequences. Understanding its etiological spectrum is essential for improving surgical safety and patient outcomes. Objective: To assess the etiological spectrum of iatrogenic urogenital fistula at a tertiary care hospital. Study Design: Cross-sectional observational study. Setting: Department of Obstetrics &amp; Gynaecology, Hayatabad Medical Complex, Peshawar, Pakistan. Duration of Study: From March 2025 to September 2025. Methods: Eighty patients aged 18–45 years with a confirmed diagnosis of iatrogenic urogenital fistula were included. Data were collected using a structured pro forma that documented age, BMI, socioeconomic status, occupation, education level, and residence. The etiology of the fistula was recorded for each patient. Diagnosis was confirmed through examination under anesthesia and cystoscopy. Statistical analysis, including assessment of associations between etiology and patient characteristics, was performed using appropriate tests with a significance threshold of P &lt; 0.05. Results: The mean age of patients was 33.08 ± 7.94 years, and the mean BMI was 24.64 ± 2.06 kg/m². Abdominal hysterectomy was the leading cause of fistula, identified in 29 cases (36.2%), followed by cesarean section in a scarred uterus in 24 cases (30.0%), hysterectomy performed for postpartum hemorrhage in 10 cases (12.5%), cesarean section in an unscarred uterus in 12 cases (15.0%), and dilatation and curettage in 5 cases (6.2%). A significant association was observed between etiology and age (P &lt; 0.001), with abdominal hysterectomy more common in older patients and cesarean-related etiologies more common among younger women. Conclusion: Abdominal hysterectomy and cesarean section, particularly in previously scarred uteri were the most common causes of iatrogenic urogenital fistula. Abdominal hysterectomy was associated with older age, whereas cesarean-related causes were more common among younger patients. Improved surgical training and perioperative vigilance may help reduce the incidence of this preventable condition.

IntroductionTimely admission and treatment of critically ill patients to Intensive Care Units (ICU) is shown to reduce premature mortality. However, low- and middle-income countries face many challenges in providing ICU services. This study describes the profile of patients admitted to ICU and their outcomes at the Central Regional Referral Hospital in Bhutan.MethodThis was an observational study with a review of records of patients from 2021 to 2023. The data were extracted into a pro forma, entered into EpiData Entry 3.1, and analysed in STATA 18.ResultsThere were 287 patients admitted to the ICU. The mean age was 56.53 (SD ± 19.18) years). The highest number of cases were admitted from the Emergency Department (117, 40.77%) and Medicine Department (50, 17.42%). The common indications for admissions were pulmonary disease (91, 31.70%), sepsis/infection (61, 21.25%), cardiovascular diseases (48, 16.72%), and cerebrovascular diseases (38, 13.24%). There were 140 (48.78%) patients who received mechanical ventilation, 27 (9.41%) required positive pressure airway support, 36 patients (12.54%) had central venous access insertion, and 19 patients (6.62%) had haemodialysis line insertion. The mortality rate was 51.22% (147/287 patients); the most common causes of mortality were septic shock (22, 14.97%), stroke (16, 10.88%), and pneumonia (14, 9.52%). Patients with chronic liver disease (adjusted OR 4.32, 95% CI 1.84–10.09, p = 0.001), and those receiving Ceftriaxone (adjusted OR 2.57, 95% CI 1.31–5.03, p = 0.006), Piperacillin-Tazobactam (adjusted OR 2.63, 95% CI 1.02–6.77, p = 0.045), and Cefazolin (adjusted OR 7.57, 95% CI 1.26–44.16, p = 0.026) had higher odds of mortality. Patients receiving Doxycycline (adjusted OR 0.49, 05% CI 0.25–0.96, p = 0.036) had lower odds of mortality.ConclusionAbout half of patients admitted to the ICU ended in mortality and the most common cause was septic shock. This study provides a baseline understanding of critical care service delivery in a resource-limited setting.Supplementary InformationThe online version contains supplementary material available at 10.1186/s12913-025-13637-1.

Large-scale transitions to eco-friendly vehicle fleets present complex capital budgeting challenges, requiring the integration of extensive operational data with financial modeling while balancing economic profitability and environmental sustainability. Traditional approaches often struggle to manage this complexity and quantify the inherent trade-offs. This study develops and applies an innovative integrated accounting-and-finance framework to evaluate the economic and environmental implications of green fleet transition projects, explicitly quantifying the trade-off between profitability and sustainability. Focusing on waste vehicle replacement of Iren Spa, a leading European multi-utility company, we employ the recently developed Split-Screen Approach, a unified accounting-and-finance framework grounded in the laws of motion and conservation. It automatically reconciles pro forma financial statements and generates internally consistent valuation metrics, eliminating the manual adjustments and inconsistencies of traditional models. Its built-in diagnostic checks and scalability for highly complex datasets overcome the manual adjustments and inconsistencies inherent in traditional financial models. We process 2303 inputs across multiple “green” scenarios. This methodology integrates an Engineering Model, describing fleet evolution, operating costs, and CO2 reduction, with a HookUp Model, which serves to transform scenarios into well-defined projects. The latter model is then integrated with a Financial Model that generates pro forma financial statements, incorporates financing and payout policies, and assesses economic profitability through Net Present Value (NPV) and consistent accounting rates of return. Together, these elements form a robust framework for managing complex data integration and analysis. Our research reveals a fundamental trade-off: enhanced environmental sustainability (measured by Net Green Value, NGV), which quantifies CO2 reduction, is achieved at the expense of economic profitability, measured by NPV. This financial sacrifice is captured by the Net Value Curve, a Pareto frontier, while the NPV-to-NGV ratio provides “shadow prices” for CO2 reduction, revealing the financial cost per unit of sustainability gained. Based on 21 project scenarios and additional sensitivity analyses on financial inputs and energy prices, the results confirm a decreasing relationship between NGV and NPV. This study makes three main contributions: (1) it demonstrates the practical application of the Split- Screen Approach for capital budgeting under complexity, (2) it introduces the Net Value Curve framework as a useful tool for visualizing and quantifying the trade-off between profitability and sustainability, (3) it provides managers and policymakers actionable insights, supporting more informed decisions in green fleet transition planning where economic and environmental objectives may conflict. The findings provide managers and policymakers with a rigorous and transparent accounting-and-finance framework that enhances the reliability of capital budgeting decisions compared with traditional financial modeling, while offering a Paretian frontier for evaluating environmental trade-offs.

Introduction: Intraocular lens implantation combined with cataract extraction is arguably the most successful surgical technique in the history of medicine. Cataracts are one of the major causes of preventable blindness worldwide. Cataract surgery is by far the most frequently performed procedure under local anaesthesia. Therefore, it is imperative to develop anaesthetic techniques that are safe, efficient, and financially viable, particularly in India. Need of the study: The study aims to provide significant insights into enhancing cataract surgical procedures in rural regions by comparing Sub-Tenon’s anaesthesia, which may offer improved akinesia and patient comfort, with topical anaesthesia, which is less invasive and easier to administer. Aim: To compare and evaluate patients’ outcomes after topical and Sub-Tenon’s anaesthesia in Manual Small Incision Cataract Surgery (MSICS). Materials and Methods: A two-arm parallel randomised controlled trial will be conducted at Acharya Vinoba Bhave Rural Hospital, Sawangi, Wardha, Maharashtra, India, from June 2024 to June 2026, including 56 patients in total (allocated to topical anaesthesia or Sub-Tenon’s anaesthesia). Before the intervention, demographic data will be collected on a pro forma, and after the surgery the Visual Analogue Scale (VAS) score and postoperative outcomes will be recorded. Statistical analysis will be performed using the Mann-Whitney U test. A p-value&lt;0.05 will be considered statistically significant.

Background: Adolescence is a transitional stage characterized by significant biological, psychological, and social changes that may predispose individuals to mental health disorders. Depression and anxiety are among the most prevalent psychiatric conditions in this age group, contributing substantially to morbidity and impaired functioning. Despite their high prevalence, these disorders often remain under-recognized, particularly in low-resource settings where mental health infrastructure is limited. The use of validated, brief screening instruments may facilitate early detection and timely intervention. Aims and Objectives: The objective of this study was to determine the prevalence of depression and anxiety among adolescents in Eastern India and to explore their sociodemographic correlates using brief, validated screening tools. Materials and Methods: This cross-sectional, observational study was conducted between January and December 2023 at the Eastern Railway Hospital, Liluah, and an adjacent co-educational higher secondary school. A total of 107 adolescents aged 10–19 years were enrolled through convenience sampling. Depression was assessed using the patient health questionnaire-2 (PHQ-2), and anxiety was evaluated using the generalized anxiety disorder 7-item (GAD-7) scale. Sociodemographic data were collected using a structured pro forma. Statistical analysis included descriptive statistics and logistic regression to identify independent predictors. Results: Of the 107 participants, 30 (28.0%) screened positive for depressive symptoms (PHQ-2 ≥ 3), whereas 47 (43.9%) screened positive for anxiety symptoms (GAD-7 ≥ 5). Moderate-to-severe anxiety (GAD-7 ≥ 10) was observed in 29.9% of respondents. Depression was more frequent in males (29.4%) compared to females (25.6%) and in late adolescents (50.0%) compared to mid (34.6%) and early (25.0%) adolescents; however, these differences were not statistically significant. Multivariate logistic regression identified anxiety as the only independent predictor of depression (Adjusted odds ratio=7.34; 95% confidence interval: 3.68–14.64; P&lt;0.001). No significant associations were observed with gender, socioeconomic status, family type, or parental education. Conclusion: This study demonstrates a considerable burden of depression and anxiety among adolescents in Eastern India, with notable comorbidity between the two conditions. The findings highlight the need to integrate brief, validated screening tools such as PHQ-2 and GAD-7 into adolescent health programs to facilitate early identification and intervention, particularly in resource-limited contexts.

Abstract Background and Aims Chronic kidney disease (CKD) is a global public health issue that significantly impairs quality of life and survival. CKD patients experience a significant symptom burden including pain, fatigue, depression, and reduced ability to perform daily activities which increase with advancing stage. Hemodialysis therapy, which, while life-extending, may not improve quality of life in those with co morbidities and in elderly. Conservative or palliative care, focuses on quality of life, is one of the pathways in management of CKD especially in advanced stages. It addresses the holistic needs of patients, including physical, emotional, and psychosocial aspects, but remains underutilized in advanced CKD. We studied our experience on the impact of conservative care and specialist palliative care referral service in advanced CKD. AimsTrends of inpatient renal supportive care consultations initiated during the given study period.Renal supportive care interventions provided in the in-patient setting.Outcomes of the supportive care consultation. Method Inclusion and exclusion criteria: After institutional ethics committee approval case records of consecutive in-patients referred from nephrology department to the kidney supportive care unit between January 1, 2019, and December 31, 2023, were analyzed. A structured study pro forma was used after removing the patient identifiers. Demography, healthcare-related factors, reasons for referral, interventions provided, and outcomes of inpatient kidney supportive care interventions were recorded. Those with incomplete records were excluded. Data was summarized on an excel sheet. Results Of 201 patients, mean age was 60 ± 15.58 years, with 139 (69.1%) males; 165 (82%), had end-stage kidney disease (ESKD), 36 (18%) had acute on chronic kidney disease (CKD). Of 201, 131 (65.2%) had diabetic kidney disease, 70 (34.8%) had CKD from other causes. Majority i.e. 190 (94.5%), were on maintenance hemodialysis (HD), 7 (3.4%) were not willing to undergo HD, and 3 (1.5%) were on peritoneal dialysis. Common co morbidities included ischemic heart disease (IHD) in 75 (37.3%), chronic obstructive pulmonary disease (COPD) in 3 (1.5%), cirrhosis of the liver (CLD) in 28 (13.9%), cerebrovascular accidents (CVA) in 20 (9.9%). Palliative medicine interventions given were end-of-life care for 50 patients (24.8%), goals of care discussions for 72 (35.8%), pain management for 47 (23.4%), supportive care for 21 (10.4%), and symptom control for 11 (5.5%). Following these interventions 71 (35.3%) experienced symptomatic improvement, 19 (9.4%) continued ongoing treatment, 29 (14.4%) had treatment withdrawal, 67 (33.3%) opted for not escalating of treatment, 4 (1.9%) patients expired, and 11 (5.5%) continued treatment at another facility. Conclusion Specialist palliative care interventions in patients with advanced kidney disease had an impact on the management process. There is a case for integrating these services in the management of advanced CKD.

Background: Schedule reliability in container liner services is essential for the efficiency of maritime and inland transport, terminal operations, and the overall supply chain. Disruptions to vessel schedules can trigger a series of disruptions at other points, generating additional operational costs for carriers, terminal operators, inland transport providers, and ultimately, for importers, exporters, and end consumers. Methods: The research paper combines literature reviews and shipping company data. A qualitative analysis contains specific causes of vessel delays and corrective actions used to realign schedules with the pro forma plan. The analysis was expanded to include transport of cargo in containers from origin to the final inland destination. Results: Disruption factors are identified and classified by their place of occurrence: (1) inland transport, (2) anchorage, (3) ports, and (4) navigation between ports. The research produced several new disruptive factors previously not identified and published. It has been confirmed that port congestion acts as the principal cause of delay in liner service. Conclusions: The findings indicate that while the number and complexity of disruptive factors are increasing due to global and regional dynamics, the range of recovery measures remains narrow. A deeper understanding of these causes enables more effective prevention, aiming to minimize supply chain disruptions and costs and increase the reliability of door-to-door container transport.

Objectives: ( 1) The objective of the study is to evaluate the sociodemographic and clinical characteristics of dementia patients, (2) to assess the caregiver burden and QOL in dementia patients and (3) to find the association of sociodemographic profile and QOL with clinical variables (cognitive impairment and severity of dementia). Materials and Methods: A cross-sectional observational study was conducted at the Dharwad Institute of Mental Health and Neurosciences from January 2020 to December 2021. Thirty consenting patients aged ≥45 years, diagnosed with dementia as per Diagnostic and Statistical Manual of Mental Disorders, 5th Edition criteria and meeting defined inclusion and exclusion criteria, were enrolled. Sociodemographic and clinical data were collected using a structured pro forma. Cognitive function and severity of dementia were assessed using the Hindi Mental State Examination and dementia severity rating scale, respectively. Caregiver burden and patient QOL were evaluated using the Zarit Burden Interview and World Health Organization-QOLBREF scales. Statistical analysis was performed using the Statistical Package for the Social Sciences version 20.0. Group differences were analyzed using the Chi-square test or analysis of variance, with a p &lt; 0.05 considered statistically significant. Results: The mean age was 67.8 years; 57% of the participants were female, 70% were illiterate, and 90% lived in rural areas. Most patients exhibited moderate (80%) or severe (13.3%) cognitive impairment. Half of the caregivers reported moderate-to-severe burden, while 17% experienced severe burden. Increased dementia severity was significantly associated with greater disability and poorer QOL (p &lt; 0.05). Higher caregiver burden correlated with lower mobility, self-care, and psychological well-being in patients. Conclusion: A cross-sectional study delineates a complex interrelationship between patient demographic factors, cognitive and functional impairment, QOL, and caregiver burden in rural dementia populations. While the severity of dementia unequivocally diminishes QOL across all domains, specific rural challenges appear greatest in psychological well-being. Caregiver burden is both a consequence and a contributor to patient outcomes, advocating for integrated, context-sensitive approaches to rural dementia care.

ABSTRACT Background: Social media has become an integral part of adolescent life, significantly influencing their self-perception and social interactions. This study aims to bridge this gap by analyzing the relationships among social media usage, social comparison, and self-esteem. Aim: To investigate the influence of social media usage on self-esteem and social comparison among adolescents and examine whether social comparison mediates the relationship between social media usage and self-esteem. Materials and Methods: A cross-sectional study was conducted across various educational institutions in Hyderabad, India, between September and November 2024. A total of 179 adolescents aged 10–19 years participated in the study. Data were collected using a semi-structured pro forma and validated scales, including the Bergen Social Media Addiction Scale, the Social Comparison Scale, and the Rosenberg Self-esteem Scale. Descriptive statistics, Pearson correlation, Chi-square tests, and mediation analysis were done using the SPSS software. Results: The study revealed a significant negative correlation between social media usage and self-esteem (r = −0.324, P &lt; 0.01), indicating that higher levels of social media addiction are associated with lower self-esteem. Mediation analysis confirmed that social comparison did not mediate the relationship between social media usage and self-esteem. Conclusion: This study highlights the direct negative impact of social media use on self-esteem among adolescents, independent of social comparison. Future research should explore the additional mediators and moderators, with a larger and more diverse sample, to provide a more comprehensive understanding of these dynamics.